CAMP LAUGHING LOON
CAMPERSHIP APPLICATION
ATTENTION: Complete all information to include our camp application and return
to Camp Laughing Loon by June 1, 2010.
Enclose copies of all necessary documentation as requested.
Child(ren) Names________________________________________________________________________________________________
Parent/Guardian
Name(s)_________________________________________________________________
Address_________________________________________________________________
City/State/Zip____________________________________________________________
Phone
(home)__________________________________(work)_________________________
The information requested below is for our records only.
How many adults (age 18 or older) live in your household? ____________
Do you share expenses for the home with anyone else? ________________
How many children are at home?__________ List names and ages:
______________________________ ______________________________________
______________________________ ______________________________________
______________________________ ______________________________________
List all employers for ALL household members. Failure to provide information could result in your application being denied.
Employer Phone Hours/Week Pay Rate
___________________ _____________________ ___________ ______________
___________________ _____________________ ___________ ______________
___________________ _____________________ ___________ ______________
___________________ _____________________ ___________ ______________
Please circle ALL benefits received and list dollar amount for ALL household members.
Social Security__________ TANF/ASPIRE__________ Food Stamps__________Child Support__________ Alimony__________ Subsidized Housing__________Medical__________ Dental__________ Pension__________Life Insurance__________ Medicaid__________ Medicare__________
Investments__________ School Lunch Program__________
Please list dollar amounts for expenses listed below.
Rent__________ Lights__________ Phone__________Car Loan_________ Other car exp.__________ Child Care__________
Food__________ Medical/Dental exp.__________Other (please list)______________________________________________________
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